BACKGROUND: EUS can provide access to the main pancreatic duct (MPD) for therapeutic intervention. The long-term clinical success of EUS-guided MPD interventions is unknown. OBJECTIVE: To determine technical and clinical success rates, predictors of success, and long-term outcomes of EUS-guided MPD intervention. DESIGN: Retrospective, single-center study. SETTING: Tertiary-care referral center. PATIENTS: Forty-five patients. INTERVENTION: EUS-guided MPD stent retrieval or placement. MAIN OUTCOME MEASUREMENTS: Technical and clinical success rates, adverse events, and long-term clinical outcomes. RESULTS: Among the 45 patients, 37 had undergone failed ERCP, and 29 had surgically altered anatomy. Median follow-up after initial EUS-guided intervention was 23 months. Two patients underwent EUS for stent removal, and EUS-guided MPD stent placement was attempted in 43 patients. Technical success was achieved in 32 of 43 patients (74%) with antegrade (n = 18) or retrograde (n = 14) stent insertion. Serious adverse events occurred in 3 patients (6%). Patients underwent a median of 2 (range 1-6) follow-up procedures for revision or removal of stents, without adverse events. Complete symptom resolution occurred in 24 of 29 patients (83%) while stents were in place, including all 6 with nondilated ducts. Stents were removed in 23 patients, who were then followed for an additional median of 32 months; 4 patients had recurrent symptoms. Among the 11 failed cases, most had persistent symptoms or required surgery. LIMITATIONS: Retrospective study design, individualized patient management. CONCLUSION: EUS-guided MPD intervention is feasible and safe, with long-term clinical success in the majority of patients. EUS provides important treatment options, particularly in patients who would otherwise undergo surgery.
BACKGROUND: EUS can provide access to the main pancreatic duct (MPD) for therapeutic intervention. The long-term clinical success of EUS-guided MPD interventions is unknown. OBJECTIVE: To determine technical and clinical success rates, predictors of success, and long-term outcomes of EUS-guided MPD intervention. DESIGN: Retrospective, single-center study. SETTING: Tertiary-care referral center. PATIENTS: Forty-five patients. INTERVENTION: EUS-guided MPD stent retrieval or placement. MAIN OUTCOME MEASUREMENTS: Technical and clinical success rates, adverse events, and long-term clinical outcomes. RESULTS: Among the 45 patients, 37 had undergone failed ERCP, and 29 had surgically altered anatomy. Median follow-up after initial EUS-guided intervention was 23 months. Two patients underwent EUS for stent removal, and EUS-guided MPD stent placement was attempted in 43 patients. Technical success was achieved in 32 of 43 patients (74%) with antegrade (n = 18) or retrograde (n = 14) stent insertion. Serious adverse events occurred in 3 patients (6%). Patients underwent a median of 2 (range 1-6) follow-up procedures for revision or removal of stents, without adverse events. Complete symptom resolution occurred in 24 of 29 patients (83%) while stents were in place, including all 6 with nondilated ducts. Stents were removed in 23 patients, who were then followed for an additional median of 32 months; 4 patients had recurrent symptoms. Among the 11 failed cases, most had persistent symptoms or required surgery. LIMITATIONS: Retrospective study design, individualized patient management. CONCLUSION: EUS-guided MPD intervention is feasible and safe, with long-term clinical success in the majority of patients. EUS provides important treatment options, particularly in patients who would otherwise undergo surgery.
Authors: Carlo Fabbri; Carmelo Luigiano; Andrea Lisotti; Vincenzo Cennamo; Clara Virgilio; Giancarlo Caletti; Pietro Fusaroli Journal: World J Gastroenterol Date: 2014-07-14 Impact factor: 5.742
Authors: Linda S Lee; Dana K Andersen; Reiko Ashida; William R Brugge; Mimi I Canto; Kenneth J Chang; Suresh T Chari; John DeWitt; Joo Ha Hwang; Mouen A Khashab; Kang Kim; Michael J Levy; Kevin McGrath; Walter G Park; Aatur Singhi; Tyler Stevens; Christopher C Thompson; Mark D Topazian; Michael B Wallace; Sachin Wani; Irving Waxman; Dhiraj Yadav; Vikesh K Singh Journal: Pancreas Date: 2017 Nov/Dec Impact factor: 3.327